The new form attached is what the Creston Community Service Club needs to process any requests for financial assistance.  Please fill out this form and return it to CCSC c/o H. Uhler, 105 Coulter Street, Creston, OH 44217 on or before November 12th, 2012

The CCSC meeting date is set for Wednesday, November 14th, at 6:00 pm at the Murray Hall Building in the Creston Park.

Thank you for your help.

Creston Community Service Club

Request for Financial Assistance

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To be considered for funding from the Creston Community Service Club, the following questions need to be answered and returned to CCSC, c/o H. Uhler,  105 Coulter Street, Creston, OH  44217 prior to November 13th of each year.  Thank you.                         

Name of Organization: _______________________________________________________

Contact Person: _____________________________________Phone: __________________

Address: __________________________________________________________________

Email address: ________________________   Number of Individuals in the program _______ 

You are a:      School Program ____   Community Program ____    Private Organization ____

                     New Program ____    Existing Program ____

Organizations yearly income ________________   Organizations yearly expenses _________________

Primary source of funding comes from: ________________________________________________

List Fund Raisers that your organization has done or plans to do in the current year: ___________

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Your request for funds from the CCSC will be used for the purpose of:_______________________

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Does your organization help at the Creston Ox Roast, if yes, please explain: ______________________

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Additional Comments: ______________________________________________________________

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_______________________________________________         ____________________________                                Signature                                                               Date